San Francisco Rhinoplasty Surgeon Dr. David Kim
A nose job, or rhinoplasty, is the surgical procedure for changing the shape of the nose. Because the nose is so central within the face, nose surgery can make a huge impact in improving one’s appearance. Rhinoplasty can also address breathing problems related to the nose.
While rhinoplasty, or nose job, is commonly known, most people don’t realize it is the most difficult of all the surgeries performed in facial plastic surgery. This is due to the complex three-dimensional structure of the nose as well as the challenge of preserving structural integrity while improving shape and appearance.
Important Rhinoplasty Concepts
- Natural looks better than “done”. In our culture, a preference for natural beauty has largely replaced an “artificial aesthetic” of past decades. The goal of cosmetic surgery should be improvements that look pleasing, but also fit an individual’s other features. Increasingly, our standards of beauty are broadening as a greater diversity of people are visible in media and culture. Dr. Kim believes that the cosmetic surgeon must be sensitive to these variations (ethnicity, culture, familial, etc) when guiding and treating patients.
- There is no one perfect nose. One of the amazing things about the human face is its diversity. With such a huge variation of individual traits, it would be a mistake to try to create the same nose for every patient. Differences based on family features, ethnicity, gender, and age all play a role.Dr. Kim spends considerable time with each patient with the aid of digital photographs taken in the clinic and a state of the art image-altering software program to determine what aesthetic goals each patient has and what outcomes will best fit each individual’s face. Some patients come with very specific results in mind, while others wish to seek more guidance in determining goals. For all patients, Dr. Kim tries to strike a balance between his/her wishes and overall aesthetic harmony. As a result, he is not known to create any one type of nose. Rather, the shapes of his patients’ noses after nose surgery are quite diverse, reflecting the wide variations of his patients’ backgrounds and preferences.
- Do no harm. Like other cosmetic procedures, a nose job is an elective procedure. Because of this, Dr. Kim strongly believes in following a safe, conservative approach to nose surgery, avoiding risky or overly aggressive maneuvers, and following a rigorous protocol before and during surgery to maximize patient safety.
- Structure equals lasting results. Traditional techniques in rhinoplasty tend to weaken the cartilage and bone of the nose. This leads to a risk of collapse, pinching, or contraction years after the nose surgery. After rhinoplasty, the nose undergoes a long-term healing process, whereby the skin and soft tissue literally contracts, much like a vacuum seal wrapper which envelopes a frozen dinner.Unless the bone and cartilage of the nose is left stable and strong after the nose surgery, this “shrink wrap” effect may cause the nose to lose shape, pinch, or collapse. This can lead to unfavorable cosmetic outcomes and breathing problems. The structural approach, used by Dr. Kim, preserves or restores the inherent stability and interconnections of the cartilages and bone of the nose. This ensures more predictable and long-term results.
Commonly Corrected Problems in the Nose
There are a wide variety of “problem areas” for which nose surgery patients have been successfully treated. These areas include (but are not limited to):
- Bump or hump on bridge of the nose
- Crooked nose
- Bridge too wide
- Bridge too flat
- Visible angles or ridges of nasal bones
- Nasal tip too wide or irregular
- Nostrils too flared or wide
- Nose too long
- Nose too short
- Nasal tip asymmetric
- Nasal tip pinched
- Nasal breathing obstruction
What Rhinoplasty Can and Cannot Do
The nose is not a lump of clay that can be molded into any form or a block of wood that can be carved into any shape. The structures on which the surgeon works are bone and cartilage, materials which are inherently awkward to manipulate. The possible outcomes following nose surgery are determined largely by the anatomy and orientation of the original nose. In essence, a nose job can only go so far. There are two concepts that explain this.
First, the bone and cartilage on which the work of rhinoplasty, or nose surgery, is done are in the nose for a reason: to support the nose as a foundation. Over-aggressive alteration of these structures weakens the stability of the nose. Therefore, the final appearance of the nose is partly dictated by its original shape and dimensions.
One can only go so far in making changes. If one tries to change a nose too dramatically, complications can occur. Also, the bone and cartilage have memory and tends to want to go back to the original position and shape. The more the structure of the nose is stressed and altered, the greater this tendency will be.
Second, the stiffness of the skin and soft tissue envelope of the nose limits the degree to which the size of the nose can be changed. Although rhinoplasty does not usually shape or mold the skin of the nose, this soft tissue envelope must be replaced and repositioned over the cartilage and bone at the end of the nose surgery. If the bone and cartilage has been reduced in size significantly during surgery, the skin envelope may not be able to drape smoothly.
Especially in patients with thicker, more sebaceous skin, the soft tissue envelope may be stiff and therefore may not settle down onto the cartilage and bone. In these cases, the changes in form created in the cartilage and bone will not be visible through the thick skin envelope and the nose may have an amorphous appearance after the rhinoplasty. Thus there is a limit on how much smaller a nose can be made, particularly in a person with thick skin.
Most patients today realize that trying to make their nose too small for their face, based on their other features and overall appearance, would not be the right approach to cosmetic nose surgery anyway.
Can’t breathe through the nose?
A procedure called a functional rhinoplasty is used to correct nasal breathing problems. As one of the top rhinoplasty surgeons, Dr. Kim performs many combination rhinoplasties in which both cosmetic and functional breathing problems are corrected in the same operation.
Corrective Nose Surgery
Do you need a previous, unsuccessful nose surgery corrected? Dr. Kim has extensive experience in performing revision rhinoplasty surgery for patients who wish to correct or improve upon their previous rhinoplasty results.
See before and after photos of cosmetic rhinoplasty procedures by David W. Kim, MD.
Schedule a Rhinoplasty Consultation Today
Dr. David Kim is widely regarded as one of the top rhinoplasty surgeons in the United States. If you have been considering cosmetic rhinoplasty, contact his practice today to schedule your comprehensive consultation. Call 415-773-0800.